PILOT MONITORING

PILOT MONITORING

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Image of the Cockpit (image embedded from Boeing on 09 October 2010)

The term was introduced to draw the distinction from the old term “pilot not flying” (PNF), that although the non flying pilot is not flying, his duties are still firmly “monitoring” the management of the flight. In this regard, one of the most important aspects of the Pilot Monitoring (PM) is cross checking the action and/or inactions of the Pilot Flying.

Errors will be made in the flight deck. It’s the monitoring and intervention by the PM that prevents them from snowballing into an undesirable state. It is however, good to keep in mind that monitoring shouldn’t only be limited to the PM but to the PF and other crewmember in the flight deck as well.

EXAMPLES OF INEFFECTIVE MONITORING:

CASE 1:

A Boeing 737-800 overrun runway 29 in Darwin International Airport at night, on the 11th of June, following an unstabillised approach. It came to a rest 44 m from the end of the runway. There were no injuries.

On that day, runway 29 was operated with a shortened landing distance due to works at the eastern end of the runway. This led to a temporary displaced that was displaced 1173 m from the original threshold. The temporary threshold was equipped with all the required lights and was provided with a portable precision approach path indicator (PAPI).

At a distance of 9.5 nm from touchdown, the rate of descent of the aircraft decreased, allowing the aircraft to get above the glide slope and unstabilising the aircraft. The crew took steps to regain profile through the use of landing gear, late extension of the flaps and the use of idle thrust throughout the approach and landing stages.

The increase descent rate allowed the aircraft to approach its correct profile albeit at a higher touchdown speed. At 100 feet above the runway, the speed of the aircraft was 29 knots above the reference speed. The aircraft floated above the runway for 650m due to the excess speed and landed 1165m from the displaced threshold.On touchdown the aircraft decelerated normally. It began to veer to the left of the centreline as it approached the end of the runway. The aircraft overran the runway at 35- 40 knots and travelled 44m into the runway safety area (RESA).

The factors which contributed to this incident are:

  1. the captain did not fly the aircraft accurately
  2. the captain didn’t comply with the company’s SOP for a stabilised approach
  3. the captain continued the approach and failed to conduct a go around
  4. the failure of first officer (Pilot Monitoring) to declare the approach unstable and call for a go around.

CASE 2:

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Garuda Airline 200 (image embedded from smh.com.au on 09 October 2010)

A Boeing 737-400 bound for Yogyakarta, Indonesia, overruns the runway on March 7, 2007. The accident was due to an unstabilised ILS approach which led to the aircraft departing the end of runway 09 at 110 knots. The aircraft was flown at an excessive speed and steep flight path angle. The Captain opted to continue the approach despite calls from the first officer to conduct a go around. The aircraft proceeded to cross a road and impacted an embankment before coming to a stop 252m from the end of the runway. The aircraft was destroyed by the impact and post impact fire. There were 119 survivors from the 140 passengers and crew.

The factors that contributed to the accident are:

  1. the breakdown in effective communication between the flight crew after the aircraft passed through 2336 feet after flap 1 was selected.
  2. the unstabilised approach flown by the captain resulting in a high approach speed of 254 knots instead of the reference speed of 150 knots.
  3. the failure of the captain to respond to the aural GPWS warning and the first officers call for a go around
  4. the inability of the first officer to over control from the captain and execute the go around
  5. the failure of the captain to conduct a go around

MITIGATING ACTIONS:

In certain airlines, the failure of the Pilot Monitoring in voicing deviations and calling for a missed approach has been recognised. In lieu of this, a process has been implemented to empower the pilot monitoring by giving the PM certain gates for certain actions.

The process:

  • Level 1: Inquiry stage: where the PM inquiries if the PF is aware of the situation.
  • Level 2: Suggestion stage: where the PM suggest alternate action to be taken
  • Level 3: Warning stage: where the PM tells the PF the actions required to be taken.
  • Level 4: Action stage: where the PM assumes incapacitation and assumes control and takes the required action.

Cultural Issues:

Studies have also identified the issues that may hinder crew interaction depending on the National Culture. The relevant concept here concerning Pilot Monitoring is that of 'Power Distance.' In Cultures of high 'Power Distance,' a leader is likely to be revered and unlikely to be challenged. A First Officer acting as the Pilot Monitoring may not challenge the Captain or speak up when required due to fear of reprisal. Appropriate Crew training is needed to over come such issues and can be taylored to a particular culture. See here for further information.

REFERENCES:

Pilot Flying and Pilot Not Flying. Retreived on 18 September 2010, from http://www.skybrary.aero/index.php/Pilot_Monitoring.

Aviation Safety Investigation Report - Final. Retreived on 19 September 2010, from http://www.atsb.gov.au/publications/investigation_reports/2002/aair/aair200202710.aspx

Want to know more?

Skybrary : http://www.skybrary.aero/index.php/Pilot_Monitoring.

ATSB : http://www.atsb.gov.au/publications/investigation_reports/2002/aair/aair200202710.aspx


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